|“My child is having trouble at school.”|
|Reading disorder (dyslexia)|
|Normal variation in rate of learning|
|Usually specific problem with reading|
|Does well in other subjects (math, etc.)|
|Understands things better when spoken, rather
|Normal eye examination|
|Decreased visual acuity|
The majority of children with reading or other learning disorders
do not have vision problems, but they should be evaluated by a pediatric
ophthalmologist to rule out this possibility. Parents should be
advised against optometric vision therapy because there is no evidence
of benefit from this expensive and time-consuming treatment.
Children with specific reading disorders, such as dyslexia, are
usually of normal or above-normal intelligence. They have a specific
problem processing written language. Early identification of such
problems allows for the development of alternative teaching methods
that can maximize the students’ education.
- 1. Dyslexia. Children with
dyslexia and other reading problems have specific difficulty processing
written information. The disorder does not result from eye or ocular
tracking problems, but rather from abnormalities in the portions
of the cerebral cortex that process written information. Treatment programs
based on “vision therapy” are of no benefit in
treating this disorder.1,2
- 2. Vision problems. Very few
children with reading problems have primary ocular problems. However,
they should be screened for these. Occasionally such children will
be found to need glasses or have some form of strabismus or other
vision abnormality that impedes reading (Table 23–1).
- 3. Normal variation in rate of learning. Normal
children learn different tasks at different rates. The speed and
ease at which children learn to read is quite variable, particularly
during kindergarten and first grade. Patients are sometimes referred
at this young age for evaluation of possible reading problems. Many
of these patients are normal (both visually and cognitively), and
will attain normal reading levels as they age.
Table 23–1. Eye
Problems that May Cause Reading Difficulty |Favorite Table|Download (.pdf)
Table 23–1. Eye
Problems that May Cause Reading Difficulty
|• Uncorrected refractive error|
|• Convergence insufficiency|
|• Dry eye|
It is important to recognize reading disorders for several reasons.
First, affected children often will benefit from alternative educational
approaches, such as the use of books on tape rather than written
information. Second, the families of such children may seek alternative
treatments, such as optometric vision therapy. These evaluations
typically result in recommendations for costly and time-consuming
treatments, for which there is no scientific evidence of benefit.
Children with reading disorders are most commonly identified
in early grade school. They are usually ...